Lindsay B D, Eichling J O, Ambos H D, Cain M E
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110.
Am J Cardiol. 1992 Jul 15;70(2):218-23. doi: 10.1016/0002-9149(92)91278-c.
Radiofrequency catheter ablation is an effective alternative to medical therapy for patients with supraventricular arrhythmias. The purpose of this study was to determine the risks to the patient and to medical personnel due to radiation exposure from fluoroscopy during radiofrequency ablation of supraventricular tachycardia. One hundred eight consecutive patients with Wolff-Parkinson-White syndrome or atrioventricular nodal reentry who underwent the ablation procedure were studied. The ablation procedure was successful in 95% of the patients studied. Preexcitation or supraventricular tachycardia recurred in 5% of the patients during a mean follow-up of 9 +/- 4 months. The mean fluoroscopy time was 50 +/- 31 minutes. An anthropomorphic radiologic phantom was used to determine organ exposure and the effective dose equivalents for the patient and medical personnel. The patient's effective dose equivalent during a representative ablation procedure was 1.7 rems, which is comparable to other invasive cardiovascular procedures. The risk of inducing a fatal cancer from this exposure is 1 chance in 745, which is 1% of the spontaneous risk. The risk of a serious birth defect is 1 chance in 80,000, which is 0.1% of the current incidence of serious birth defects in the United States. The cardiologist who receives the highest exposure among medical personnel, would incur 1.8 mrems per case or 450 mrems per year if 250 procedures were performed. This exposure is 9% of the recommended annual limit. These results demonstrate the efficacy of radiofrequency energy ablation of supraventricular tachycardia and confirm that radiation exposure to patients and medical personnel is within established guidelines.
对于室上性心律失常患者，射频导管消融术是一种有效的药物治疗替代方法。本研究的目的是确定在室上性心动过速的射频消融过程中，透视辐射对患者和医务人员造成的风险。对连续108例患有预激综合征或房室结折返性心动过速并接受消融手术的患者进行了研究。95%的研究患者消融手术成功。在平均9±4个月的随访期间，5%的患者出现预激或室上性心动过速复发。平均透视时间为50±31分钟。使用一个人体放射学模型来确定患者和医务人员的器官暴露情况以及有效剂量当量。在一次代表性的消融手术中，患者的有效剂量当量为1.7雷姆，这与其他侵入性心血管手术相当。由此暴露导致致命癌症的风险为745分之一，即自发风险的1%。严重出生缺陷的风险为80000分之一，即美国目前严重出生缺陷发生率的0.1%。在医务人员中受辐射最高的心脏病专家，每例手术将受到1.8毫雷姆的辐射，若进行250例手术，则每年受到450毫雷姆的辐射。这种辐射量是推荐年剂量限值的9%。这些结果证明了射频能量消融室上性心动过速的有效性，并证实患者和医务人员的辐射暴露在既定指南范围内。
